The Management of Atrial Fibrillation after Coronary Artery Bypass Graft Surgery

1
The Management of Atrial Fibrillationafter
Coronary Artery Bypass Graft Surgery

• KellyAnn Prime
• RN Bsc Hons

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Objectives

• List demographics of coronary heart disease
• List incidence of atrial fibrillation
• Identification of atrial fibrillation
• Discuss causes of atrial fibrillation
• Discuss treatment options
• Apply theory to practice

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Content

• Demographics
• National Service framework
• Atrial fibrillation and CABG
• What is atrial fibrillation
• Causes of atrial fibrillation
• Symptoms of atrial fibrillation
• Diagnosis of atrial fibrillation
• Management of atrial fibrillation
• Complications of atrial fibrillation
• Q A

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Demographics

• Cardiovascular disease - 216,000 deaths in 2004
• Coronary heart disease 105,000 deaths in 2004
• CHD 32 of premature deaths in men , 24 in women
• (BHF 2005)

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National Service Frameworkfor CHD

• To reduce deaths in lt 75yrs by 40 83.8 deaths
  per 100,000 by 2010 (DOH 1999)
• Implementing standards of care using clinical and
  cost effective measures.

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Atrial fibrillation and CABG

• gt30,000 CABGS per year (BHF 2006)
• One side effect of CABG atrial fibrillation
• 1 in 20 people gt 65yrs (Hubbard 2004)
• 20 40 of patients who undergo CABG will
  experience AF
• Peri- operative AF- severe left ventricular
  dysfunction

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Atrial Fibrillation

• - Normal pathway disrupted by extra impulses
  stimulating the atria loss of synchrony
• - extra stimuli originates outside one or more of
  the pulmonary veins abnormal atrial tissue
  maintains arrhythmia
• upper chambers of atria fibrillate
  ventricular rate fast and erratic (Hubbard 2004)
• Roaming re- entry circuits diffusing around areas
  of fixed or functional conduction blocks
  (Archibold and Schilling 2004)
• Paroxysmal vs spontaneous
• Acute onset vs persistent

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Diagnosis of AF

• ECG lack of p waves
• Low BP decreased cardiac output- body
  compensation
• Ventricular rate 120-200 bpm

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Causes of atrial fibrillation

• CHD and MI
• Hypertension
• Valvular Heart disease (mitral stenosis)
• Thyrotoxicosis
• Pericarditis
• Myocarditis
• Heart Failure
• Chest Infection
• Sino atrial disease
• Age related degeneration in the atrial myocardium
• CT surgery/ electrolyte imbalance
• Excess vagal activity
• Emotional stress
• Excessive alcohol consumption (Hubbard 2004)

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Symptoms of AF

• Breathlesness
• Dizziness
• Palpitations
• Haemodynamic parameters

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Management of atrial fibrillation

• Rate control
• Rhythm control
• Anticoagulation therapy
• Restoration of sinus rhythm
• Pharmacological / non pharmacological treatments

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Complications of AF

• Clot formation
• Emboli (pulmonary, systemic)
• Decreased cardiac output
• Angina
• Dizziness and syncope

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QA

• CASE STUDY